Breast asymmetry in idiopathic scoliosis (IS) patients with structural thoracic curve: a computed tomography (CT) morphometric analysis and assessment of patients' perceptions using the Breast-Q™ questionnaire

Chris Yin Wei Chan; Siti Mariam Mohamad; Heng Keat Tan; Chee Kidd Chiu; Mun Keong Kwan

doi:10.1007/s43390-025-01080-5

Breast asymmetry in idiopathic scoliosis (IS) patients with structural thoracic curve: a computed tomography (CT) morphometric analysis and assessment of patients' perceptions using the Breast-Q™ questionnaire

Spine Deform. 2025 Apr 5. doi: 10.1007/s43390-025-01080-5. Online ahead of print.

Authors

Chris Yin Wei Chan¹, Siti Mariam Mohamad², Heng Keat Tan², Chee Kidd Chiu², Mun Keong Kwan²

Affiliations

¹ Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia. chrnat01@yahoo.com.
² Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.

PMID: 40186824
DOI: 10.1007/s43390-025-01080-5

Abstract

Purpose: To quantify the breast computed tomography (CT) parameters in IS patients. Patients' perceptions of their breast appearance before/after scoliosis surgery were also assessed with Breast-Q™ questionnaire.

Outcome measure: Concave/convex side breast volume difference (BVD), computed tomographic external breast appearance parameters (extraversion angle (EA), coverage angle (CA), axial breast height (ABH), nipple-to-sternum distance (NSD), thoracic rib cage parameter (inclination angle (IA)), and Breast Satisfaction and Psychosocial Well Being domains of Breast-Q Q™ questionnaires.

Methods: This was a prospective study of 50 IS patients recruited between June 2017 and December 2018 who had pre-operative CT scans available for review. Pre-operative radiological parameters as stated above were evaluated. Breast volume difference (BVD) was calculated using the formula: 100 * {(CC BV - CV BV)/[(CC BV + CV BV)/2]}. Breast-Q™ questionnaires were administered pre-operative and post-operatively. The percentage of patients who achieved the minimal clinically important difference (MCID) was reported.

Results: Thirty-three patients (66%) had significant BVD with the concave side larger in 52.0% of patients. BVD had significant correlation with ABH, NSD, CA, and EA. There was no significant correlation between pre-operative Cobb angle with BVD and IA. There was also no significant correlation between Tanner stage and the radiological parameters. Breast satisfaction and psychosocial well-being domains improved after surgery and the satisfaction with breast domain minimal clinically important difference (MCID) was achieved in 83.7% of patients, while the psychosocial well-being domain reached the MCID in 75.5% of patients (p < 0.001).

Conclusion: Scoliosis led to significant breast asymmetry among patients with smaller volume on the convex side. Changes in breast volume (BV) contributed significantly towards the external breast appearance. Patient's breast satisfaction and psychosocial well-being improved post-operatively and, in the majority, MCID was achieved.

Keywords: Breast asymmetry; Breast volume; Idiopathic scoliosis; Patients’ perception.